Strep throat stomach pain

Children complaining of stomach pain is common, and some sources – like constipation, food allergies or even appendicitis – are obvious.

But a few illnesses might not come to mind first when considering the source of a child’s stomachache. Here is information from the American Academy of Pediatrics (AAP) about some causes of stomach aches that might surprise parents.

Strep throat
Even though this diagnosis is tied to another relatively distant body part, strep throat can also cause stomach pain.

An infection caused by a bacterium called streptococci, strep throat’s more obvious symptoms are a sore throat and fever, and sometimes vomiting or headaches.

Parents who suspect their child has strep throat should visit the pediatrician, who will swab the child’s throat to test for bacteria. If positive, the physician will prescribe antibiotics.

Urinary tract infection (UTI)
Though the tell-tale sign of a UTI is pain and burning during urination, these infections can also cause discomfort in the abdomen.

UTIs are a common ailment in children, with more than 1.3 million children treated annually for the condition. Girls ages 1 to 5 are more likely than other children to experience a UTI.

Parents who suspect their child has such an infection should visit the pediatrician, who will prescribe an antibiotic following a positive diagnosis.

Learn how to prevent UTIs in children.

Emotional upset
Stomach pain can also be the result of sadness, stress or anxiety. Though this type of pain is more common in school-age children, children younger than 5 under unusual stress may also experience it.

Parents should carefully assess the child for other symptoms that might indicate an illness such as fever, vomiting, weakness, pain while urinating, sore throat or diarrhea. If none of those are present, consider other aspects, like timing: Does it wax and wane over a period of more than a week, and surface around activities that are unpleasant or stressful?

A lack of other physical symptoms and pain with curious timing could point to emotional upset. In this case, talk to the child about what’s bothering them. A pediatrician can also suggest ways to help, and, if necessary, refer the child to a therapist, psychologist or psychiatrist.

When to call the doctor

No matter the source, stomachaches should be taken seriously. Not all aches require a doctor’s appointment, but here are some signs from the AAP that medical attention is necessary:

  • Abdominal pain that comes on suddenly or persists
  • The child has other symptoms, such as a change in his bowel pattern, vomiting, fever (temperature of 100.4°F or higher), sore throat or headache
  • A baby younger than 1 year shows signs of stomach pain such as legs pulled up toward the abdomen or unusual crying
  • A child aged 4 or younger has recurrent stomachache
  • If abdominal pain awakes a child or stops him from sleeping

Death by Strep: One Family’s Tragic Loss

That type of transmission, however, is exceedingly rare, Dr. Sabella notes. “Group A strep is generally spread from person to person,” he explains. “Picking it up from objects or pets or carpets is not usually possible. The main modes of transmission are through droplet spread, contact with respiratory secretion, or direct contact with skin.”

Strep that gets into the skin is generally riskier – in part because it can more easily spread to other parts of the body, such as the bones, the joints, or the blood – but not all skin cases are severe, and not all throat cases are benign.

“Are there specific factors that make one group A strep more virulent than another? We don’t know exactly,” Dr. Malley explains. “If you look at all of the group A strep, even though those bacteria have the same name, on a genetic level, they’re very, very different. It’s a bit like the human race: We’re all people, but we have enormous differences in our DNA, and those differences result in differences in our height, our skin color, our eye color, etc.”

Among the various strains of group A strep, he continues, certain bacteria may produce more of a specific type of toxin or poison, which might translate into more or less virulence, or a more or less aggressive nature.

“The other side of the coin,” he says, “is the host. You might be very resistant to group A strep, for example, but I might fall apart. And the difference might just be your genes compared to mine, or your past exposure compared to mine. … It’s very hard to say that one person is protected and another person is not. It’s a complicated issue.”

Strep deaths are uncommon. Millions of people are infected every year, but only a small percentage of those cases are invasive, and only a small percentage of those cases – 10 percent to 14 percent, or approximately 1,200 to 1,600 of the CDC’s estimated 12,000 – result in death. Streptococcal toxic shock, which is what is believed to have killed Rory, is even more unusual, especially among children. There are less than 600 cases a year in the country.

Those numbers, of course, mean nothing to Staunton. But these do. “Strep has cost me 25 percent of my family,” he says. “Fifty percent of my children. That’s the reality I’mliving with.

“It is a horrible form of torture that has been inflicted on us, on Rory,” he adds. “One Tuesday, I’m picking out what kind of toppings he wants on his pizza, and the next Tuesday, I’m speaking at his funeral. Someone needs to send a message: There’s a killer on the loose.”

‘Well One Day, Sick the Next’

The Stauntons are not alone. Less than 20 miles from their Queens home, a Rockville Centre, Long Island, family is coping with the same reality. Sean Sweetman, 2, died in February under circumstances remarkably parallel to Rory’s. He, too, was reportedly diagnosed with a stomach virus that turned out to be invasive group A strep. He, too, was taken from his family just days after getting sick.

Similar stories from around the country – an 8-year-old girl in Ohio, a preschooler in Virginia, a toddler in Oregon – are part of the reason why Staunton is speaking out.

“There’s nothing out there for me. Rory isn’t coming back,” he says. “But if our story helps save someone else’s son, maybe some good can come of this. Maybe we’ll be the last people to be tortured by the loss of a child to strep.”

Awareness will help, but experts say some deaths can’t be prevented, in part because there’s often no cardinal sign that indicates strep over another infection.

“Unfortunately, bacteria, when they hurt the host, tend to hurt the host in much the same way as other bacteria: with fever and pain,” Children’s Hospital’s Dr. Malley says. The more distinct red flags occur later, when the illness has already progressed.

With streptococcal toxic shock, for example, the first symptoms may be fever, chills, muscle aches, nausea, and vomiting, all of which could be indicative of other conditions, such as the flu. As the bacteria spread throughout the body, however – usually within 24 to 48 hours of exposure – patients may experience rapid deterioration presenting as low blood pressure, accelerated heart rate, bright red skin, excessive bruising, yellowed eyes, tissue necrosis, and pain or swelling at the site of infection.

“It’s very acute, meaning the person is well one day and sick the next,” Dr. Malley explains. Because of this, invasive strep cases can be difficult – but not impossible – to treat.

“Toxic shock, especially with strep, can be very, very aggressive,” Dr. Sabella warns. “Fortunately, we do have antibiotics that are active against the strep itself. But a lot of times, it’s the toxins from the strep that cause the damage. We usually have to do significant debridement or drainage of the soft tissue; that’s surgical treatment to clean out the tissues and to allow the antibiotics to get where they need to go to treat the bacteria.”

In Rory’s case, surgery wasn’t an option. “It was gone too far,” Staunton recalls. “No matter what they were throwing at it, it killed everything.” He wipes away a tear, that is immediately replaced by another one. “He was my best friend.”

A Family’s Last Goodbye

“He used to steal my clothes, you know,” Staunton says. “Only the good ones. I got this beautiful shirt from my wife for Christmas, and he came down one morning dressed for a debate, and there it was. I said, ‘That’s my shirt!’ He said, ‘Not anymore.’”

Rory was buried in that shirt. “The last thing I had to do was get his shoes cleaned, get my shirt cleaned, and iron his pants to bring to the funeral,” his father says,weeping again. “I must have ironed his pants 40 times that morning.”

The funeral, attended by more than 1,000 people in New York, was also streamed live to friends and family around the world. Shortly after, Rory boarded his final flight: a one-way trip to Ireland, where officials stamped his passport for the last time. There, in the shadow of St. Peter’s Church in Drogheda, 30 miles from Dublin, loved ones lowered him into the ground next to his grandmother, who died when Rory was 3.

“Spiritually, emotionally, we couldn’t bear the thought of him lying alone in a graveyard without anyone around him and where no one knew him,” Staunton says. “So we buried him where we know friends and family visit all the time.”

Staunton is quiet for a moment, thinking. “Does that make sense?” he asks. Nothing seems to anymore.

“You see your child’s name on a headstone…” he begins. His voice, already barely above a whisper, breaks, trails off.

“It’s unnatural.”

Strep throat – causes, symptoms, treatment

Strep throat, also called streptococcal sore throat, is an infection of the throat and tonsils caused by Streptococcal bacteria. Typical symptoms are sore throat, chills, fever, and swollen lymph nodes in the neck. Strep throat is cured by antibiotic treatment. If left untreated, strep throat can cause serious heart and kidney complications.
Sore throats can be associated with colds and flu, tonsillitis and strep throat. This page deals primarily with strep throat. Refer also to our tonsillitis and influenza (flu) pages.

Causes

The majority of sore throats are caused by viruses, most commonly a cold or flu virus. A viral sore throat will usually get better by itself, and has a low likelihood of complications.
A sore throat caused by bacteria, however, has a higher chance of complication and requires more attention. A sore throat in children that is accompanied by headache, high fever, stomach-ache, vomiting or severe tiredness, with or without a red rash, indicates the need for a visit to a family GP.
Although many types of bacteria can cause throat infections, Streptococcus, or strep, is the most common cause of bacterial sore throat.
Strep throat is contagious. It is spread by close contact with an infected person, often by inhaling airborne droplets from an infected person’s coughs and sneezes. It can also be spread through shared food or drinks.
Close-quarter living conditions, such as a family home, and school and university hostels, provide an ideal environment for the transmission of strep throat from one person to another.
Children between the ages of 5 and 15 years have the highest incidence of strep throat.
A strep throat infection may involve inflammation of the tonsils (bacterial tonsillitis). However, treatment of the condition is likely to be different to that for viral tonsillitis.

Signs and symptoms

Symptoms of strep throat develop one to four days after exposure to the bacteria via airborne droplets or by direct contact with an infected person.

The most characteristic symptoms of strep throat are sore throat and painful swallowing. Other symptoms include:

  • Chills and fever
  • Swollen and tender glands (lymph nodes) on the sides of the neck
  • Red and swollen appearance inside the throat
  • Pus-like white or yellow patches or spots may be visible on the back of the throat and on the tonsils
  • Headache, nausea and vomiting may also be present
  • Earache
  • Body aches and pains.

Some people will develop a red skin rash that feels rough to the touch. A strep throat infection accompanied by this distinctive rash is known as scarlet fever. The rash is caused by toxins produced by the Streptococcus pyogenes bacterium.

Complications

Potential complications of untreated strep throat infection include middle ear infection (otitis media), sinus infection (sinusitis), pneumonia, meningitis, kidney disease, and rheumatic fever. Of these, rheumatic fever and kidney disease are of most concern.
Rheumatic fever
Rheumatic fever is a serious complication of strep throat. Untreated or inadequately treated strep throat may result in bacteria remaining in the tonsils stimulating a persistent immune response. The on-going immune response may cause inflammation in other parts of the body including the brain, heart, joints and skin. This is rheumatic fever and it usually occurs two to four weeks after a strep throat infection.
The most serious consequence of rheumatic fever is that inflammation affecting the heart can cause scarring of the heart valves, necessitating heart valve replacement surgery.
Those at highest risk of developing rheumatic fever are young and of Maori or Pacific ethnicity living in lower socioeconomic regions of the country. The number of New Zealanders of Pacific ethnicity admitted to hospital with rheumatic fever is approximately eight times higher than the national average. the number of Maori admitted to hospital with rheumatic fever is about twice the national average.
Visit the Ministry of Health’s rheumatic fever webpage for more information.
Kidney disease
The response of a person’s immune system to a strep throat infection may also cause inflammation of the kidneys (post-streptococcal glomerulonephritis). This form of kidney disease is more common but less serious than rheumatic fever.
It usually occurs one to three weeks after a strep throat infection, and typically resolves on its own within several days without causing any long-term kidney damage. Children are at the highest risk of developing this condition following a strep throat infection. Symptoms may include blood in the urine, swollen ankles and puffy eyes.

Diagnosis

Diagnosis of strep throat is important because starting antibiotic treatment within 48 hours lessens the duration of symptoms by one to two days, cuts down the risk of rheumatic fever and kidney disease, and reduces the risk of disease transmission to other people. During a GP visit, a throat culture might be taken by touching a cotton swab to the throat and tonsils. The swab is then sent to a laboratory where strep throat is confirmed by bacteriological culture and identification of the streptococcal bacteria in the throat swab.
Although throat culture is the definitive test for a strep throat infection, the results usually take 24-48 hours to come back to the GP.
A Rapid Antigen Detection Test (or RADT), which also involves taking a swab of the throat and tonsils, may also be done. Although the RADT can provide results within minutes, it is not as precise as a throat culture.
If strep throat is strongly suspected, both the throat swab and RADT may be performed and antibiotic treatment started immediately, even if the RADT test is negative, while waiting for the throat swab results to come through. If the throat swab result does not confirm streptococcal infection, the antibiotics will be stopped.

Treatment

Because of the potential for serious complications, strep throat should be treated with antibiotics as soon as possible. Antibiotics used to treat strep throat include the following:

  • Phenoxymethyl penicillin: is taken orally and is the most commonly prescribed antibiotic for strep throat.
  • Amoxicillin: is a useful oral penicillin alternative as it can be given with food, which may help people to remember to take all of their doses.
  • Benzathine benzylpenicillin or procaine penicillin: is given as a single intramuscular injection and may be used in patients who are unable to take penicillin orally or are unlikely to complete the 10-day oral course.
  • Erythromycin ethyl succinate: is a suitable oral antibiotic alternative for people who are allergic to penicillin.

With oral antibiotic treatment, the full 10-day course must be completed, even if symptoms resolve after only two to three days, to ensure that the infection does not return and to minimise the risk of developing rheumatic fever and kidney disease.
Symptom relief for sore throat can be gained from a saltwater gargle (half teaspoon of salt to a cup of warm water) and sucking throat lozenges containing ingredients that are cooling, anaesthetic, anti-septic, or anti-inflammatory.
Pain relief and reduction of fever can be obtained from use of over-the-counter paracetamol and ibuprofen.

Surgery

Surgical removal of the tonsils may be recommended for people who have recurrent strep throat. Surgery does carry some risks, including bleeding during and after the operation in some people. Throat pain and difficulty eating is usual in the first few days after the operation. Full recovery typically takes two to three weeks.

Prevention

An important part of managing a strep throat infection is to prevent its spread to other people. Simple steps to help prevent the spread of strep throat include:

  • Covering the mouth and nose with a tissue when sneezing or coughing
  • Frequent and thorough washing and drying of hands
  • Avoiding close physical contact
  • Not sharing food, liquids, or eating or drinking utensils with an infected person
  • If strep throat is confirmed, staying home for 24 hours after starting antibiotic therapy

Support and information

Additional information about strep throat and rheumatic fever can be obtained from Healthline, which is a free 24-hour telephone advice service provided by the Ministry of Health. Healthline is staffed by registered nurses who can advise and recommend appropriate care for callers with symptoms.
Free phone: 0800 611 116
Website: www.healthline.govt.nz
Kerdemelidis M, Lennon D, Arroll B, Peat B. Guidelines for sore throat management in New Zealand. N Z Med J. 2009;122(1301):10-8. http://www.nzma.org.nz/__data/assets/pdf_file/0004/17788/Vol-122-No-1301-21-August-2009.pdf
Khan, Z.Z. (2017). Group A streptococcal (GAS) infections (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. http://emedicine.medscape.com/article/228936-overview#a2
Ministry of Health (2017). Sore throat (Web Page). Wellington: New Zealand Government Ministry of Health. http://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/sore-throat
O’Toole, M.T. (Ed.) (2013). Rheumatic Fever. Mosby’s Dictionary of Medicine, Nursing & Health Professions (9th ed.). St Louis, MI: Elsevier Mosby.
O’Toole, M.T. (Ed.) (2013). Strep throat. Mosby’s Dictionary of Medicine, Nursing & Health Professions (9th ed.). St Louis, MI: Elsevier Mosby.
Ministry of Health (2017). Previous BPS target: Reduce rheumatic fever (Web Page). Wellington: New Zealand Government Ministry of Health. http://www.health.govt.nz/about-ministry/what-we-do/strategic-direction/better-public-services/previous-bps-target-reduce-rheumatic-fever
Last reviewed: September 2017

Sore Throat

Is this your child’s symptom?

  • Pain or discomfort of the throat
  • Made worse when swallows
  • Rare symptom before 2 years old
  • Not caused by an injury to the throat

Causes of Sore Throat

  • Colds. Most sore throats are part of a cold. In fact, a sore throat may be the only symptom for the first 24 hours. Then a cough and runny nose occur.
  • Viral Pharyngitis. Some viruses cause a sore throat without other symptoms. A cough and runny nose don’t become part of the illness. An antibiotic won’t help.
  • Strep Pharyngitis. Group A Strep is the most common bacterial cause. It accounts for 20% of sore throats without any cold symptoms. Pus is seen on the tonsils. Peak age is 5 to 15 years. An antibiotic is helpful.
  • Mono. Infectious Mono mainly occurs in teens and young adults. The main symptoms are sore throat, fever and widespread swollen lymph nodes. Like Strep, Mono also has pus on the tonsils. Patients with Mono also may have a large spleen. It’s located in the upper left side of the stomach. Mono is diagnosed with special blood tests.
  • Post-nasal Drip. Drainage from a sinus infection can cause a sore throat. The throat clearing that goes with the drainage may cause most of the irritation. The sinus infection is more likely to be viral than bacterial.
  • Mouth Breathing. Breathing with the mouth open during sleep can cause a sore throat. After eating breakfast, it often goes away.
  • Abscess of Tonsil (Serious). A bacterial infection of the tonsil can spread to the surrounding tissues. The main symptoms are severe trouble swallowing, fever and one-sided throat pain. It’s also hard to fully open the mouth. The peak age is teens.
  • Epiglottitis (Very Serious). A bacterial infection of the flap of tissue above the vocal cords. It normally covers the windpipe during swallowing. The main symptoms are severe sore throat, drooling, spitting and fever. It can shut off the airway. Needs a 911 response.

Strep Throat: When to Suspect

  • Symptoms include sore throat, fever, headache, stomach pain, nausea and vomiting.
  • Cough, hoarseness, red eyes, and runny nose are usually not seen with Strep throat. These symptoms point more to a viral cause.
  • Scarlet fever rash (fine, red, sandpaper-like rash) is highly suggestive of Strep throat.
  • Peak age: 5 to 15 years old. Not common under 2 years old unless sibling has Strep.
  • If you think your child has Strep, call your doctor.
  • Your doctor will do a Strep test. If the test is positive, they will start treatment. There is no risk from waiting until a Strep test can be done.
  • Standard treatment is with antibiotics by mouth.

Symptoms in Infants and Toddlers

  • Children less than 2 years of age usually don’t complain about a sore throat. A young child who does not want favorite foods may have a sore throat. They may also start to cry during feedings. Their symptoms are usually better covered using Drinking Fluids – Decreased care guide.

When to Call for Sore Throat

Call 911 Now

  • Severe trouble breathing (struggling for each breath, can barely speak or cry)
  • You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

  • Trouble breathing, but not severe
  • Great trouble swallowing fluids or spit
  • Can’t open mouth all the way
  • Stiff neck or can’t move neck like normal
  • Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
  • Purple or blood-colored spots or dots on skin
  • Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
  • Fever over 104° F (40° C)
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent. Note: a Strep test alone is not urgent.

Call Doctor Within 24 Hours

  • Sore throat pain is severe and not better 2 hours after taking ibuprofen
  • Large lymph nodes in the neck
  • Pink rash that’s widespread
  • Earache or ear drainage
  • Sinus pain (not just congestion) around cheekbone or eyes
  • Fever lasts more than 3 days
  • Fever returns after being gone more than 24 hours
  • Age less than 2 years old
  • Close contact to a person with Strep within last 7 days
  • Sores on the skin
  • You think your child needs to be seen, but the problem is not urgent (or needs a Strep test)

Call Doctor During Office Hours

  • Sore throat is the main symptom and lasts more than 48 hours
  • Sore throat with cold/cough symptoms lasts more than 5 days
  • You have other questions or concerns

Self Care at Home

  • Viral throat infection suspected

Seattle Children’s Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

Care Advice for Sore Throats

  1. What You Should Know About Sore Throats:
    • Most sore throats are just part of a cold and caused by a virus.
    • A cough, hoarse voice or nasal discharge points to a cold as the cause.
    • Most children with a sore throat don’t need to see their doctor.
    • Here is some care advice that should help.
  2. Sore Throat Pain Relief:
    • Age over 1 year. Can sip warm fluids such as chicken broth or apple juice. Some children prefer cold foods such as popsicles or ice cream.
    • Age over 6 years. Can also suck on hard candy or lollipops. Butterscotch seems to help.
    • Age over 8 years. Can also gargle. Use warm water with a little table salt added. A liquid antacid can be added instead of salt. Use Mylanta or the store brand. No prescription is needed.
    • Medicated throat sprays or lozenges are generally not helpful.
  3. Pain Medicine:
    • To help with the pain, give an acetaminophen product (such as Tylenol).
    • Another choice is an ibuprofen product (such as Advil).
    • Use as needed.
  4. Fever Medicine:
    • For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
    • Another choice is an ibuprofen product (such as Advil).
    • Note: Fevers less than 102° F (39° C) are important for fighting infections.
    • For all fevers: Keep your child well hydrated. Give lots of cold fluids.
  5. Fluids and Soft Diet:
    • Try to get your child to drink adequate fluids.
    • Goal: Keep your child well hydrated.
    • Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
    • Solid Foods: Offer a soft diet. Also avoid foods that need much chewing. Avoid citrus, salty, or spicy foods. Note: Fluid intake is much more important than eating any solid foods.
    • Swollen tonsils can make some solid foods hard to swallow. Cut food into smaller pieces.
  6. Return to School:
    • Your child can return to school after the fever is gone. Your child should feel well enough to join in normal activities.
    • Most often, having just a sore throat is not a reason to miss school.
    • Children with Strep throat need to be taking an antibiotic for 24 hours.
  7. What to Expect:
    • Most often, sore throats with a viral illness last 4 or 5 days.
  8. Call Your Doctor If:
    • Sore throat is the main symptom and lasts more than 48 hours
    • Sore throat with a cold lasts more than 5 days
    • Fever lasts more than 3 days or goes above 104° F (40° C)
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 02/01/2020

Last Revised: 03/14/2019

Copyright 2000-2019 Schmitt Pediatric Guidelines LLC.

— — An Ohio girl is recovering after a rare complication from strep throat led to a dangerous infection, which required amputation of one leg.

Tessa Puma, 6, was diagnosed with necrotizing fasciitis, an infection by what is commonly called flesh-eating bacteria, which can spread quickly in the body. Her father, Matt Puma, said doctors believe the dangerous infection was caused by bacteria from her strep throat.

Tessa was diagnosed with strep throat earlier and took antibiotics. But when she was struck with the flu last week, her parents noticed she was complaining of pain in her arms and legs. They took her to two hospitals before doctors diagnosed an additional problem: necrotizing fasciitis.

“They did some more tests and confirmed she had the flu and saw she had some kind of infection,” Puma said. “She spent a couple of days in the hospital, and her leg got worse and worse.”

At one point, simply touching Tessa made her scream in pain. When doctors performed surgery to relieve swelling, they found extensive damage in her left leg as well as parts of her shoulder and back.

Necrotizing fasciitis can occur after bacteria from a strep or other bacterial infection migrates to the bloodstream and infects the fasciae, or membranes surrounding muscles and other internal organs, according to the U.S. Centers for Disease Control and Prevention. The infection can kill tissue as it spreads, causing serious complications that can require amputation or result in death.

In Tessa’s case, doctors believe the strep bacteria migrated to her bloodstream, causing the dangerous infection. When doctors could no longer find a pulse in her leg, they concluded she likely had too much dead tissue. To help her heal, they amputated her left leg from the knee down.

Puma said the doctors told him, “If there was any kind of hope for her to live and survive, it’s going to be best to amputate her leg.”

Tessa is recovering at Akron Children’s Hospital but will need further surgery and additional portions of her left leg removed to help her survive. But her father said that she has a strong will and that he believes she will eventually return to what she loves: dancing.

Poststreptococcal Inflammatory Syndromes

If rheumatic fever or another strep-related disease is suspected, your child’s doctor will perform a throat culture and/or send blood work to look for evidence of a prior strep infection. Blood work may also be useful to look for general signs of inflammation or to rule out other causes of the symptoms. If post-strep glomerulonephritis is suspected, your child may be referred to a cardiologist to get an EKG (electrocardiogram) and echocardiogram, or to a nephrologist.

If there is concern for strep, the patient will be prescribed antibiotics. Typically, penicillin or amoxicillin are prescribed. If the patient has a history of allergies to these medications, a different class of antibiotics may be used. After completing a treatment course of antibiotics, children with rheumatic fever are typically treated with low-dose antibiotics until adulthood in order to prevent reinfection and possible heart damage. Aspirin and other NSAIDs are helpful for joint pain complaints Other medications may be required if other organs are affected.

Summit Medical Group Web Site

What is rheumatic fever?

Rheumatic fever is a disease that causes inflammation (swelling and redness) of various parts of the body. The disease can damage the heart, joints, brain, and skin.

What is the cause?

Rheumatic fever is caused by a reaction to a strep throat infection. Why some people have this reaction to strep bacteria is not well understood. It appears to be a response by the body’s immune system.

Most people with strep throat do not get rheumatic fever. You are more at risk for rheumatic fever if you have had:

  • An untreated strep infection
  • An incompletely treated infection because you didn’t finish all of the medicine prescribed for you, or
  • Several strep infections

You can have rheumatic fever at any age, but it is most common in children.

You can have rheumatic fever at any age, but it’s most common in children.

What are the symptoms?

Symptoms, which usually start 2 to 3 weeks after a sore throat, may include:

  • Aching and swollen joints (ankles, knees, elbows, wrists), with the pain and swelling often moving from joint to joint
  • Fever
  • Tiredness
  • Chest pain
  • Shortness of breath
  • Jerky, uncontrollable movements of the face, arms, and legs
  • Red, flat, painless, and nonitching rash on the chest and belly or arms and legs
  • Small bumps under the skin on the elbows or knees

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:

  • Blood tests
  • A throat culture
  • Chest X-ray
  • An echocardiogram, which uses sound waves (ultrasound) to see how well the heart is pumping
  • An ECG (also called an EKG or electrocardiogram), which measures and records the heartbeat

How is it treated?

The treatment may include:

  • Antibiotic medicine to kill the strep bacteria
  • Aspirin or another anti-inflammatory medicine to control fever, joint pain, and inflammation
  • Steroid drugs to treat inflammation of the heart
  • Medicine to help control jerky movements
  • Bed rest until you have a normal temperature without medicine
  • Several weeks of decreased activity

Rheumatic fever can last from 6 weeks to more than 6 months. Your long-term health depends on how your heart has been affected by the disease. Rheumatic fever can weaken the heart muscle and affect your heart’s ability to pump. The heart valves may also be affected. One or more valves may become scarred and after a while may have trouble opening and closing properly. Damage to the valves may not show up until years after the illness. Eventually, the valve may need to be repaired or replaced with surgery. Starting antibiotic treatment early when you have rheumatic fever may prevent permanent damage to the heart.

It’s very important to prevent recurrences of rheumatic fever because the severity of heart trouble is related to the number of attacks of rheumatic fever. You may need to take penicillin regularly for months or years to keep from getting more strep infections. How long you will need to take preventive penicillin (or a different antibiotic if you are allergic to penicillin) depends on many factors. The recommendations change every few years as more is learned about how to prevent and treat the complications of rheumatic fever.

How can I take care of myself?

  • Take all medicines as prescribed.
    • Take the full course of antibiotics prescribed by your healthcare provider.
    • Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, you should not take this medicine for more than 10 days.
    • Using a steroid for a long time can have serious side effects. Take steroid medicine exactly as your healthcare provider prescribes. Don’t take more or less of it than prescribed by your provider and don’t take it longer than prescribed. Don’t stop taking a steroid without your provider’s approval. You may have to lower your dosage slowly before stopping it.
  • Drink lots of fluids
  • Damaged valves may become infected if they are exposed to bacteria during surgery or dental work. Infection of the valve can damage it more. Antibiotics can help prevent infection. Ask your healthcare provider if you should take antibiotics before you have dental work or medical procedures.
  • Follow the full course of treatment prescribed by your healthcare provider. Ask your healthcare provider:
    • How and when you will hear your test results
    • How long it will take to recover
    • What activities you should avoid and when you can return to your normal activities
    • How to take care of yourself at home
    • What symptoms or problems you should watch for and what to do if you have them
  • Make sure you know when you should come back for a checkup.

How can I help prevent rheumatic fever?

Tell your healthcare provider if you have a

  • Sore throat and fever that last more than 24 hours
  • Severe sore throat without cold symptoms
  • Sore throat after being around someone with a strep throat

Treating strep throat infections with antibiotics can usually prevent rheumatic fever.

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